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ABSTRACT: The purpose of this study was to evaluate whether age influences collateral development in patients with coronary artery
disease. The extent of collateral development to the area perfused by the infarct-related artery was graded, depending on
the degree of opacification of the occluded infarct-related artery. We evaluated the extent of collateral development using
coronary cineangiography in 102 patients with an acutely occluded infarct-related coronary artery within 12 h after the onset
of the first acute myocardial infarction, and who had a history of long-standing effort angina. Well-developed collateral
circulation was observed in 54 (53%) of the patients. The patients were divided into two groups based on their age. The prevalence
of well-developed collateral circulation in the younger group (≤64 years, n = 48) was 69% (33 of 48), being significantly (P = 0.003) higher than 39% (21 of 54) in the older group (≥65 years, n = 54). We conclude that in the presence of stimuli for collateral development i.e., long-standing effort angina accompanied
by severe coronary stenosis, the age of patients is a key determinant of collateral development.
Key words Age-Angina pectoris-Angiogenesis-Collateral development
Heart and Vessels 04/2012; 15(4):176-180. · 2.05 Impact Factor
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ABSTRACT: Background: Ventricular remodeling after acute myocardial infarction is a precursor of the development of overt heart failure and is an important indicator of mortality However, clinical and angiographic determinants of ventricular remodeling have not been fully elucidated. The purpose of the present study was to evaluate the effects of long-standing preinfarction angina and the late reperfusion of the infarct-related coronary artery on ventricular remodeling and function.
Methods: Coronary angiography and left ventricular cineangiography were performed 35 16 days after the onset of acute myocardial nfarction in 80 patients with a relatively recent anterior Q-wave myocardial infarction who had received conventional therapy.
Results: In patients with preinfarction angina that occurred more than 1 week before the onset of myocardial infarction, the left ventricular size and ejection fraction were better preserved than in those without preinfarction angina. On the other hand, the late reperfusion of the infarct-related coronary artery did not affect ventricular remodeling.
Conclusion: Our results indicate that the presence of residual flow to the infarct area through the collateral circulation, presumably developed by repetitive Ischemic stimuli, appears to be a crucial determinant of subsequent left ventricular size and function in patients with acute myocardial infarction who have had conventional therapy.
(C) Lippincott-Raven Publishers.
Coronary Artery Disease 08/1994; 5(9). · 1.24 Impact Factor
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ABSTRACT: Objectives. The purpose of the present study was to evaluate whether severe restenosis after percutaneous transluminal coronary angioplasty (PTCA) promotes collateral development and whether successful dilation regresses collateral vessels.Background. It is well known that in the presence of severe coronary stenosis, native collateral arterioles mature to small coronary arteries with several layers of smooth muscle cells. However, it remains unclear whether well developed collateral vessels regress after removal of coronary stenosis.Methods. The study group comprised 41 patients who underwent elective PTCA for effort angina due to single-vessel disease, followed by repeat PTCA to treat restenosis. We classified the patients into three groups depending on the change in baseline Thrombolysis in Myocardial Infarction (TIMI) flow grade of the ischemia-related artery at initial and repeat PTCA, and we compared the extent of ST segment elevation at 1 min of the first balloon inflation between the two procedures. The average interval from initial to repeat PTCA was 125 days.Results. The three patient groups comprised group A, 12 patients with decreased flow grade because of severe coronary restenosis; group B, 12 patients with increased flow grade who had severe initial stenosis and relatively mild restenosis; and group C, 17 patients with unchanged flow grade. In the presence of comparable rate-pressure products at initial and repeat PTCA, patients in group A had significantly greater ST segment elevation (p < 0.01) at initial than at repeat PTCA (mean ± SD 0.42 ± 0.31 vs. 0.13 ± 0.22 mV). In group B, ST segment elevation was significantly less at initial than at repeat PTCA (0.13 ± 0.25 vs. 0.19 ± 0.17 mV, p < 0.05), and in group C, it was comparable at the two procedures (0.37 ± 0.32 vs. 0.35 ± 0.33 mV, p = 0.50).Conclusions. These findings indicate that severe restenosis after PTCA promotes collateral development and that successful dilation regresses collateral vessels during a relatively short period of time.(J Am Coll Cardiol 1997;29:544–8)
Journal of the American College of Cardiology.
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ABSTRACT: Objectives. The purpose of this study was to evaluate whether a serotonin blocker, sarpogrelate, improves exercise capacity as a result of vasodilation of coronary collateral channels in patients with effort angina.Background. Serotonin has been reported to decrease coronary collateral blood flow by collateral vasoconstriction in a canine model, suggesting that platelet activation in feeding coronary arteries of the collateral network has the potential to cause collateral vasoconstriction.Methods. The subjects consisted of 22 patients with effort angina and reproducible ischemic threshold (group A, 11 patients with thrombolysis in myocardial infarction (TIMI) grade 2 or 3 flow of the ischemia-related coronary artery and Rentrop’s collateral index 0 or 1; group B, 11 patients with TIMI grade 0 or 1 flow and Rentrop’s collateral index 2 or 3). We repeated the symptom-limited treadmill exercise test using the Balke–Ware protocol and exercise tetrofosmin myocardial perfusion scintigraphy with and without pretreatment with 200 mg orally administered sarpogrelate. Each exercise test was performed at 9:00 a.m. on different days. The order of tests with and without sarpogrelate was randomized.Results. In group A, sarpogrelate increased neither exercise time at 0.1 mV ST depression nor double product at 0.1 mV ST depression. In contrast, in group B sarpogrelate increased the exercise duration at 0.1 mV ST depression from 181 ± 112 (SD) to 248 ± 131 s (p < 0.05) and also increased the double product at 0.1 mV ST depression by 21% (p < 0.01). The severity score using myocardial perfusion scintigraphy at the same workload was significantly (p < 0.01) decreased by 37% in group B, but not in group A (11%), due to the sarpogrelate treatment.Conclusions. Sarpogrelate augments flow reserve of the collateral circulation and improves exercise capacity in anginal patients with well-developed collaterals. These findings indicate that a serotonin blocker, sarpogrelate, is useful not only as an antiplatelet drugs, but as an antianginal drug.
Journal of the American College of Cardiology.
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ABSTRACT: Objectives. The purpose of this study was to test the hypothesis that the incidence of restenosis after primary percutaneous transluminal coronary angioplasty for acute myocardial infarction is largely influenced by the preexistent coronary collateral circulation to the infarct-related coronary artery.Background. The occurrence of restenosis after coronary angioplasty is the most limitation of this procedure. However, prediction of restenosis is difficult. Severe preexistent stenosis of the infarct-related coronary artery causing the development of collateral circulation may result in a high frequency of restenosis.Methods. The study group consisted of 152 consecutive patients undergoing primary coronary angioplasty within 12 h after the onset of a first acute myocardial infarction. Of this group, 124 patients were angiographically followed up during the convalescent period of infarction and were classified into two groups according to the extent of preexistent collateral circulation to the infarct-related coronary artery.Results. Restenosis occurred in 26 (38%) of 69 patients with poor or no collateral circulation (group A) in contrast to 35 (64%) of 55 patients with good angiographic collateral circulation (group B, p < 0.005). The frequency of preinfarction angina was significantly lower (p < 0.05) in group A (26% [18 of 60]) than in group B (44% [24 of 55]).Conclusions. These findings indicate that the presence of well developed collateral circulation to the infarct-related coronary artery predicts a higher frequency of restenosis after primary coronary angioplasty. The difference in restenosis rates observed between the patients with and without good collateral circulation probably reflects the impact of underlying severity of stenosis on the long-term outcome after coronary angioplasty.
Journal of the American College of Cardiology.
